Hi, I am reading 3 recent reports and am trying to figure out if several things are important to my spinal problems.

First of all is Anterolisthesis (mild) of C3 on C4 (3mm) and minimal Anterolisthesis of C7 on T1. Would that be causing me any of my pain? Also there is an anterior osteophyte projecting from the vertebral body of C4.

7 years ago I had Fusion surgery of C5/6 6/7 with titanium pins and plates and donor bones. I never did fuse at C6/7 and still have a lot of pain!!! I never did have any relief after surgery and have been in pain ever since. Neurosurgeon not even a year later after not even taking x-rays to see if I was fused sent me to pain clinic and was treated for bones spurs and arthritis on C3/4 and C7 and also had decompression treatments (39 treatments) on DRX7000 machine. Still in lots of pain and not fused.

After my surgery 7 years ago on the diagnostic imaging report it states: Two views were obtained and demonstrate anterior cervical fusion extending from the C5 level to the C7 level with metallic plate and screws present. Also that there is a bone graft present. Also the last line that I am wondering about says:

THERE IS A MILD DEGREE OF ANTERIOR SUBLUXATION OF C3 ON C4.

I have had major problem with headaches before my surgery for years and woke up after surgery with the same headache . I had a headache for at least 4 years constantly before and after maybe longer!!!. My pain management doctor finally put me on "topomax" 2 per day for the headaches which (cross my fingers) helps for them. My questions is "Is Anterolisthesis and Anterior Subluxation of C3 on C4" both the same thing and should they have been addressed when I had my original surgery?
That shows up on 2 different reports!!!!

I know that area on my neck and it hurts so bad and nobody listens to me. I know I need surgery but when I woke up after surgery and every since surgery the pain has never gone away, could that be why???

Just trying to be a detective because this chronic pain is there and real and I know everyone on these boards knows what I am going through!!

Re: Anterolisthesis of C3 on C4 (is it the same as Anterior Subluxation?

Here is my understanding of the terms(since I had it too)

Spondylolisthesis, both anterior and posterior, is mainly used with the lumbar area and graded in grades 1-4, with 1 being minimal and 4 being a total dislocation of one vertebra over another. Dislocation and subluxation are somewhat interchangeable.

In the neck, they don't grade the spondylolisthesis as the neck can't take the amount of dislocation the lumbar can. They do grade them as minimal to severe to indicate how out of place it is. Any misalignment of the vertebrae can be considered a subluxation but it is most often used after a sudden shift in the bones. Many of us are born with vertebrae out of alignment so your neck wouldn't be considered to have "subluxated" as you were born with it. It would be congenital.

So if the C3-4 anterolisthesis was there since birth, there would be no reason to fix it. You were just born with C3 sitting slightly forward of C4. It is stable. However, it it happened suddenly and was unstable and rocking back and forth, then it would be a subluxation and in need of fixing.

A lot of our spine problems are from being born with vertebrae slightly out of alignment and that brings on arthritis and other problems.

When my neck collapsed, 3 months after surgery, I did subluxate 5 vertebrae because they had MRI's showing where they had been. C3 and 4 went backwards, C5 went frontwards, C6 went back and C7 went froward. They had all been that way prior to surgery but very slightly. Once the ligaments went, they slipped far more and were very unstable. I went from a slight loss of the normal lordosis to complete reversal. And I broke 3 of the 4 bone grafts put in. One bone graft impaled my cord slightly(thank goodness).

BTW, the only way to fix it all was a long fusion....C3 to T1. If they had fixed yours too, you would have been looking at the same thing and may be looking at it now. A lot of docs don't want to do long fusion as they bring a lot of complications and they try to do a short one first in hopes things will settle down. Your doc gambled and lost but he should have had the guts to at least follow you properly and fix it when it didn't work.

Re: Anterolisthesis of C3 on C4 (is it the same as Anterior Subluxation?

Jenny.....Wow I feel so bad for you!!! I understand more now what you are going through!!! Thank you so much for explaining this to me. I haven't gone through with anything yet as this orthopaedic doctor really upset me and I have been playing detective for the last few days going over and over my medical notes as I know I am in so much pain in C3/4 and C6/7 as 6/7 didn't fuse and now my eyes go to another report that also says minimal anterolisthesis of C7 on T1.
How can I tell if I was born with this or it just occurred? I guess I have to see if this ever showed up on any report before, is that correct?
Going back again into my reports as I said earlier that after my surgery it showed a mild degree of anterior subluxation of C3 on C4.
Now reading the report from Oct. 12/2010 from 4 flexion cervical spine views it changes to:
There is mild anterolisthesis of C3 on C4 by 3mm, seen on the flexion view only. There is minimal anterolisthesis of C7 on T1. There is an anterior osteophyte projecting from the vertebral body of C4. It also says mild degenerative change of the cervical spine as described. THAT is not true because the anterolisthesis or anterior subluxation shows on the report "on the day of the surgery". I must be reading something wrong into this. I am frustrated here!!!!
Also this doctor seen on these flexions studies and I will quote: On flexion/extension views, there does appear to be some motion at the C6-7 pseudoarthrosis level with relative widening of the pseudarthrosis gap at the C6-C7 level on flexion. There may also be some lucency6 about the C7 screws within the C7 vertebral body!!!!!
This all might be just something I am misinterpreting Jenny but just wanted your opinion about the above and below vertabrae.
Thanks again for your help.
Lyn AngelinMichigan

Re: Anterolisthesis of C3 on C4 (is it the same as Anterior Subluxation?

If the anterolisthesis was there on surgery day and afterward, then it's probably been there all along. They figure out if it's been there for a while by seeing how stable it sits on the lower vertebra. It's like having a bad bite with your jaw. If the teeth fit together, then you were born with the bad bite. If the teeth don't fit the bite, then it might be something that happened as a result of injury.

If it's been there all along and the bones fit together okay, then you leave them alone...if it ain't broke don't fix it sort of thing.

So I suspect that earlier tests may have overlooked it as it looked like a good fit. They often don't report stuff that appears to be congenital.

As for the other stuff...the translucency of the screws at C7...that is something they watch. I have to have yearly x-rays of my knee replacements for the same thing. Metal screws are stronger than the bone so the bone, sensing that something strong is there, will start to let some of it's calcium go. No need to be strong in the presence of a strong screw. But that loss of calcium weakens the bone to the point where the screw can come loose or cause a fracture. That is why replacement knees and hips get replaced again and again....the bone weakens and they come loose. Normal.

The other stuff about the widening of the gap at the pseudoarthrosis on flexion....I assume that is where the non-fusion took place and they can see it when your neck is flexed. The "pseudoarthrosis is your fused area. This is your main problem.

The "protruding osteophyte"...that's a bone spur sticking out.....what else is new with your neck. You have arthritis.

Oh...and the other spondy at C7-T1 is probably from the fusion above it. Once they fuse several vertebrae together, they tend to stick out a little one way or the other. A fusion is actually bigger than the other areas so it may be more of an illusion than anything else....bigger bone sticks out more and therefore is now considered a spondylolisthesis. You need to realize that they are talking about millimeters here.

If you worry about that...then what do you think about this....my grade 1 spondylolisthesis in my lumbar spine has disappeared after 30 years. Where did it go? You'd think that is a good sign but now my back is more unstable. It was a stable spondy and now that it's gone, it's no longer stable. But what do you fix? Nothing. You wait and see if it causes any damage.

These slight mis-alignments of the vertebrae as seen from the side or the back are really, really common and a lot of them also occur as we age. When we are young, we have a deep curve inward in our necks. By the time we die, most people have necks that are almost straight or curved slightly outward. The spine is dynamic and moves and with movement, we get slight mis-alignments......doesn't mean anything is wrong or that anything has to be fixed.

Your big problem is that you shouldn't have a gap in your fusion area. I wouldn't worry about the slight mis-alignments. You need to have the fusion re-done if they can. That is the source of your pain.

I suspect that what they will finally propose to do is what is called a 360* fusion. Since it didn't fuse from the front, they go in the back and fuse that side. Then you are fused all around the spine....360*.

Anyone suggest this yet?

hugs..........Jen

The Following User Says Thank You to jennybyc For This Useful Post:ANGELINMICHIGAN (11-08-2010)

Re: Anterolisthesis of C3 on C4 (is it the same as Anterior Subluxation?

Jennybyc.....Hello!!! Sorry I took so long to answer your post. Babysitting my grandchildren takes a lot out of me and then I was so busy the next day cleaning and the time goes by so fast.

Jenny, I cannot tell you how much I appreciate you taking your time to help me. There should be more people in the world like you. All that you have gone through and are still going through and you are on these sites helping people read their MRI's to ease their minds. You should get a metal!!!! Do you understand all of this because of what you have gone through yourself or have you also been in the medical field?

You asked me about if anyone has offered me the fusion going in through the back of my neck so that I would have a 360 deg. fusion.

The last doctor or Orthopedic surgeon that I just went to on the first appt. said that "if he was to offer me surgery when I came in the next time with the results of my Cat Scan and MRI" (because the only thing he had right then was 4 "flexion scans" that he had just taken) was that he would go in through the back and clean up what was going on(arthritis, bone spurs) and take a bone graph from my hip as my original fusion was 2 donor bones and then do the fusion. That is when he told me about the possible lucency of the screws and the widening of the gap at C6-7. When I came back the second time and he gave me the results of the MRI and cat scan, I am sure this time he said something about going thru the front again like the first time (he said it so fast and almost under his breath and I didn't question him, but said he would do surgery and in the next breath said because I was upset he would not do surgery, so that is why I am confused. He said I needed it but wouldn't do it on me!!!

I told him I suffer every day 24/7 and my arms are constantly aching and my fingers are numb and tingly constantly and that didn't matter to him.Sometimes I can hardly lift them. He did his little pushing pulling tests (real scientific) and said that my strength was perfect and there was nothing wrong with them (OK) I don't even know how to sit and watch tv at night. I have not been comfortable ever with or without a collar my neck just aches constantly and oh I could go on and on (but I won't) but he didn't seem to care.
Now whatever I have to get done, my co-pay is $20,000 because he wouldn't do anything under my insurance that I have had for 35 years and now that my husband has retired we have very expensive insurance because I have a "pre-existing" condition.

He said "I was forcing him to operate on me" (HA HA)....talk about someone making you doubt your self worth!!!

Oh well!!!!! Thank you again Jenny for explaining it to me, I appreciate your valueable time. I hope you are not in too much pain. What is your pain level like daily?
I send you gentle hugs. Take care of yourself.

Re: Anterolisthesis of C3 on C4 (is it the same as Anterior Subluxation?

Hi Lyn....sounds like he was talking about a 360*. Also sounds like he thought you might need that screw removed from the front as well. You can't get them out from the back if they were put in from the front.

But as I've said before, they don't operate for pain. They send you to pain management for that. They operate for signs of nerve damage. You have no lose of strength so that means you have no visible signs of nerve damage.

Have you ever seen a therapist who specializes in pain management? They can really help you with the emotional side. I swear mine keeps me sane at times. Some pain management clinics have them on staff. It sounds like that is where you are headed for right now. Seems the docs don't see enough nerve damage to justify surgery. And a lot of them don't like working with people they see as emotionally unstable. Did you know that the increase in stress hormones from anxiety can delay healing? Learning how to relax and meditate and control the stress in the face of pain is really, really great.

That is how I stay calm. I am allergic to the morphine family of drugs and the oxycodone family. I have over 40 drug allergies and tend to run families once I start them. I can't afford to take any pain meds unless I am in agony. So I did therapy. I learned self-hypnosis and biofeedback and use the 2 of them together to control pain and my reaction to it. And I throw in some prayer with it just to make it a sure bet.

On a daily basis I am in pain but how much I'm never quite sure. My therapist, based on physical reactions, thinks I'm somewhere between 7-8 daily. I've kind of developed my own pain scale. My 10 is not everyone else's 10. When I had my knees replaced(both at the same time)my PCA(the IV pain med thing) failed for 4 hours during the night and I found myself at 3am with no pain meds in me. The resident who oversaw the pain control department had turned off her beeper and no one could find her. I was close to stroking out from the pain. So my 10 is not what most people know as a 10. All I could do was try to meditate....and cry(sob actually).

So I now know what my physical symptoms say. Nausea...I'm getting up to 8, needing to be totally alone....9, crying, sobbing......10. But daily, I'm always on the edge of the nausea....I've been having it daily for the past couple of weeks so I know my body is experiencing a lot of physical stress. But I just keep cool and relaxed and try to not feel it. I take nothing stronger than ibuprofen and Tylenol in combination.

So you can learn to take control of the pain and I highly recommend it to anyone willing to try. I've taken a lot of heat on the Pain Management boards for this but I don't care....I'm not on narcotics and they are. When I was in the hospital in March for suspected infections in my knee joints(wasn't bacterial thank heavens), they had to tap my knee joints almost daily and with no local anesthetics. The nurses would look away....couldn't figure out how I could lay there and just let them do it with nothing in my system and no local. But I did. I just need to look out the window and go "elsewhere" in my head.

Re: Anterolisthesis of C3 on C4 (is it the same as Anterior Subluxation?

Quote:

Originally Posted by ANGELINMICHIGAN

I told him I suffer every day 24/7 and my arms are constantly aching and my fingers are numb and tingly constantly and that didn't matter to him.Sometimes I can hardly lift them. He did his little pushing pulling tests (real scientific) and said that my strength was perfect and there was nothing wrong with them (OK) I don't even know how to sit and watch tv at night. I have not been comfortable ever with or without a collar my neck just aches constantly and oh I could go on and on (but I won't) but he didn't seem to care.

He said "I was forcing him to operate on me" (HA HA)....talk about someone making you doubt your self worth!!!

Angel in Michigan

Hey ANGELIINMICHIGAN, how are you?. I also feel pain in the neck 24/7. It's a serious problem when I need to lay my neck on the pillow. My pain level is 8 daily if I won't take oxycontin 40mg now. I also take a very low dose of gabapentin and 4mg clonazepam all for pain.

I remember you had to stop all your meds. what meds are you taking now.
I have this belief you suffer from this pain since your car accident. Sometimes it can show up years later.
all the best, god bless.;

Re: Anterolisthesis of C3 on C4 (is it the same as Anterior Subluxation?

Jenny and nochange

Thanks again Jenny for your reply. Yes I have a PM doctor and have gone to him for years. He has tried everything for me. He has done several different injections including cortizone shots into various vertabraes, botox, steriod injections which took away some of the pain and maybe lasted a few hours and then the pain was back. Then I started nerve ablations. I had them several times in several different areas starting in the occipital a few times hoping my headaches would go away and they lasted maybe 6 months and then moving down into the lower vertabrae having 1 side at a time done. This helped the pain but then I felt like I had a sunburn for about 6 months and that was very uncomfortable. He did this about 6 times and the sunburn feeling was just as bad as the pain so I stopped that. But I did go to him for about 3 years. He did suggest that I go and see someone (psychiatrist) at one time. I do not understand how going to see someone to talk about my life when I was young and what my parents were like to me and my siblings and what my home life now is life and what my thoughts and feeling are have to do with my chronic pain when my neck is out of alignment and I have bone spurs, arthritis and non fusion on C6/7 from surgery 7 years ago and lucency of one of the screws now after surgery.
And yes "nochange" I did have a car accident 6 weeks after my surgery and who knows what damage that caused. What I do know is that my arms and hands are always heavy and achy feeling and my fingers go numb, that doesn't mean that I can't feel still feel them at all. If the doctor pushes or pulls on them I can still push and pull back my fingers they are tingly, "he can't feel inside my fingers, he can't feel that they are tingling"!!! Also as I said in my last post, my feet are always numb feeling and tingly and purple looking especially in the morning. I have had them tested before several times but nobody ever relates them to my neck. When I read on the boards a lot of people say they have the same thing and it relates to their neck!!!

I guess I just can't understand, when I know that I have a problem in my neck and I can see it on paper and have the disc of my cat scan, mri and 4 flexions (which to me is the proof right in my hand that something is definitely wrong) and the orthosurgeon does want me to have surgery...he just wants me to see someone first.

nochange....I do not take narcotics for pain....the neurosurgeon that did my fusion surgery 7 years ago....I kept on going to him because I was still in a lot of pain afterwards every several months gave me percocet in the hospital and then changed to vicodin and then I went off of it. After the car accident I had to go back on percocet. He never checked me until I was almost a year, just told me I had Fibromyalgia. Finally gave me a CT myelogram and said that above discs were degenerating and tooks x-rays finally to say C6/7 never fused!!! Wanted to do fusion surgery over again and include C3/4 but I asked the wrong question and he asked me to leave. Still in pain my GP gave me Oxycontin or Oxycodone. Never ever took an extra pill and my body started craving more and I wouldn't take it. I started to get restless legs pretty bad and instead of taking a larger dosage or an extra pill my body started to go into withdrawl and I went to a clinic for a week and won't go into any more details. It was the "worst thing hands down that I have ever been through in my life" beside this chronic pain"!!!
I have a neuroligist now that gives me: Topomax for my headaches that does keep them at bay, I take Ambien as I don't sleep and haven't for many years because of the chronic pain
Cymbalta, for Fibromyalgia and depression (even though I am not depressed outward, just being in chronic pain is depressing I guess)
Omeprazole for acid reflux
Gapabentin for nerve pain
Also I take 2 tylenol per day or 2 arthritis pills whatever I grab for.

Re: Anterolisthesis of C3 on C4 (is it the same as Anterior Subluxation?

Lyn, I'm not talking about seeing a therapist to talk about your life or childhood. Many deal with chronic pain and can teach you how to control pain with your own mind. You can learn how to release your natural endorphins....the best pain killer there is.

Think of it this way....we all know how we can get so upset it makes our BP rise. You are releasing adrenaline...makes the BP go up. Also makes the blood sugar rise. And then goes on to create a cascade effect on your whole body. It's called stress!

Well if you can cause that to happen, how can you make the opposite happen...how to stop the release of adrenaline and instead, release endorphins. That is what they can teach you. Some will even hook you up to a machine that will make a noise when you bring down your BP. You can hear yourself taking control over functions that you thought you had no control over.

It has nothing to do with "therapy" but teaching you how to take control over your own mind in times of pain.

Just today I had a systemic reaction to my allergy shots. Second time in 2 months...last time my BP plunged and I was really in trouble. Today, when it started, it looked like it would be the same thing but instead I went into deep meditation and it slowed down. Didn't have to use my Epi-Pen...just Benedryl. I've brought myself out of many asthma attacks this way. And even had dental work and minor surgery with just the deep meditation. It works....and has nothing to do with my childhood. But you have to look for someone who deals with chronic pain and how to control it. Not all therapists do it. Look for someone who does "bio-feedback" for the type that uses a machine to show you how you control your own body.

You have the problem that they know something is wrong but don't really know IF they fix it will it will change anything. But and it's a big but.....it might make you worse. Have you ever considered that possibility? Bet that is why your doc said no....he sees a bad outcome.

Re: Anterolisthesis of C3 on C4 (is it the same as Anterior Subluxation?

Jennybyc.....Thanks again for your advice and help, I appreciate it as always.

I may be in chronic pain and get upset in the doctor's office when I am talking about my neck, as when I see that a doctor "might be able to help me" I get emotional as I really want my pain to go away. One might say "all of us in chronic pain might feel emotional and obsessed about getting helped when you feel the way we do" but....my blood pressure whether in the doctor's office or out is perfectly normal. It always has been and going to the doctors office whether it be my GP or a specialist never changes.

He does not know me outside of his office and he shouldn't label me a stressed out emotional depressed person just because he looks on my list of pills and sees that I take "Cymbalta", or maybe "Ambien" because I don't sleep because of the pain. We are judged wrongfully because of our history that they look at on a sheet of paper and they are looking at us for the first time. I could go on and on but whoever is reading this will agree with me 100% if they know my story. It is really not fair!!!

I have chronic neck problems, my arms ache, my shoulders ache, I have heavy painful arms which go into my hands which are numb and tingly. The doctor says push on my hands and you can still push with your achy and tingly arms and hands and he puts on the report "there is nothing wrong with her arms and hands" He can't feel what you feel inside. He can't feel that your fingers feel tingly when he feels your finger. I am not going to waste everyone's time typing all of the rest of what I feel!!!! I know you all understand and have been there at one time or another!!!!

It was told on these boards that the doctor doesn't care about our pain!!! Only what is going on that is going to paralys (sp) us (this is not an exact quote), is that because they are worried about law suits. They spend more time writing down notes that are going to cover their asses than listening to us. While he was writing down so much crap about me, I tried to get in other thing that was going on with my symptoms and that came back to "bite me in the *** so to speak" because in his notes he said "patient interrupted me constantly" which took up more of my 15 minutes for him to write that down...wow how cruel. Then he told me I needed surgery but basically because he made me cry because he was so "insensitive to the way I felt" he said he wouldn't operate...He told me when I had calmed down and went to see "somebody" then come back and then he "might operate"!!!!

Well I would never go back to him.

I have a list of better doctors now so maybe that was a "warning" to not go to an "orthopaedic surgeon" which he was but to go back to a "neurosurgeon surgeon" who did my surgery in the beginning. (That didn't turn out to well either)

I have a list of surgeons from Jenny and Sammy and am going to check them out very carefully and will get 2 opinions this time.

Renster, hope everything is going well with you. Will check everything out on the site you are on!!!

Re: Anterolisthesis of C3 on C4 (is it the same as Anterior Subluxation?

One important note is that doctors do not really understand much about neck pain. For example, I have 2 bulging disks in my neck and I went to the pain clinic, over there the pain doctor told me 99% of this pain is my pure imagination and wanted me to go on anti depressant, I refused. I've been on amitrapliine(spelling) before but that didn't help the pain and not the sleep.

Then I went back to my doctor and he believes I have chronic pain and that it's not my imagination. He never even asked me to go on anti depressants.

But that is the deal. Doctors just don't really understand why somebody suffers from chronic pain. I believe once you get injured in the neck there is a damage there and then you have this chronic pain no matter what.